Episode 325- How Michigan Medicine Sees The Path To Lower Costs. David Miller, M.D., MPH

Healthcare affordability is having a moment, and not the vague kind. From the Mackinac Policy Conference, we sit down with Dr. David Miller, Executive Vice Dean for Clinical Affairs at Michigan Medicine and President of the University of Michigan Health System, to talk about what it takes to lower the total cost of care while protecting access to top-tier clinical outcomes for patients across Michigan.

We start with timely news: Michigan Medicine will continue its partnership with Blue Cross Blue Shield, easing uncertainty for people who rely on specialty care and were wondering whether they could even schedule their next visit. From there, we zoom out to the bigger policy and operational pressure points across the healthcare ecosystem: how to reduce complications in high-acuity care, why primary care and earlier intervention can prevent expensive crises later, and what “value-based insurance design” looks like when you’re serious about paying for treatments that are proven to work.

Then we get practical about AI in healthcare. Dr. Miller explains where ambient AI documentation is already reducing administrative burden, why technology-enabled medical education is becoming essential across the health professions, and how evidence from imaging and stroke triage can move innovations from promising demos into real clinical policy. We also talk about rural hospitals and lower resource environments, and how a statewide network can use technology to spread expertise beyond urban centers. We close with the financial reality of medical education and student debt, and what Michigan can do to keep the next generation of clinicians here. If this conversation helps you think differently about affordability, share it, subscribe, and leave a review so more people can find it.

Transcript

Announcer 

This episode of *The Common Bridge* is part of a special 21‑part series of interviews recorded with healthcare leaders from across Michigan during the 2026 Mackinac Policy Conference in partnership with the Michigan Health and Hospital Association. In these short conversations with his guests, Rich explores regulation, cost pressures, workforce challenges, and the future of health care in Michigan and around the country.

Rich Helppie  

We’re at the Mackinac Policy Conference today on behalf of the Michigan Health and Hospital Association and, of course, *The Common Bridge* podcast and Substack page. Today we’re talking to Dr. David Miller of Michigan Medicine. He is the Executive Vice Dean for Clinical Affairs and the President of the University of Michigan Health System. Dr. Miller, it’s great to see you.

Dr. David Miller  

Rich, it’s great to see you again. I’m grateful to be here, and thanks for being here and talking about health care in the state all day today. This is fantastic.

Rich Helppie  

Quite the buzz around affordability at a business conference where health care has center stage.

Dr. David Miller  

Yeah, I think it’s an important moment in health care. The concept of affordability is real and important. As a leading academic medical center, we’re all‑in on helping to identify solutions.

Rich Helppie  

And you’ve been at the front of the news cycle lately about affordability, in that our largest insurer in the state and our preeminent academic medical center had a hard time coming to terms. But it sounds like we have some good news.

Dr. David Miller  

We’re pleased that we announced we’re going to be continuing our partnership with Blue Cross, and most importantly, continuing to provide access for patients across the state who rely on the world‑class care at Michigan Medicine. So some good news to start the day, Rich. Thanks very much.

Rich Helppie  

Fantastic.

Dr. David Miller  

And most importantly, good news for our patients. As you know, I still see patients, and for the last couple of weeks my patients would say at the end of the visit, “So should we schedule our next visit?” First they’d ask, “Are you involved in this at all?” and I’d say, “A little bit, a little bit.” Then they’d say, “Should I?” And I would say, “I know it’s a moment of uncertainty, but I think both we and our colleagues at Blue Cross are committed to finding a solution.” We’re glad that we have.

Rich Helppie  

Well, I’m very, very happy to hear that—and on to the next challenge. When you look at the totality of our health care delivery and financing system and think about places that could be improved, what policy changes come to mind?

Dr. David Miller  

It’s a great question and one that’s at the center of some of the pressure points in health care right now. You have clinical care delivery systems, you have health care financing and payers, you have pharmaceutical companies and others who are part of the health care ecosystem. The focus ultimately needs to be on the dollar invested and the health outcomes achieved. I think there are opportunities in several areas.

First is the more acute care setting—a lot of what we do at Michigan Medicine. For patients undergoing complex surgery, how do we make sure we’re focused on the right decision‑making and utilization, and then on complication‑free episodes of care—avoiding adverse outcomes after major surgery? That’s one area where health systems have spent years working and refining.

A second area is continuing our emphasis on primary care. For patients diagnosed with conditions that can progress over time, how do we ensure that access and the interventions that matter are made immediately available? There have been some interesting concepts on the financing side there. A colleague at Michigan Medicine has talked about value‑based insurance design, which means reimbursing for the things that are proven to work well, and then having the best conversations about not doing the things that aren’t working as well. There’s a real art of medicine in that.

Finally—and this is where I think there’s a big opportunity, Rich—is upstream of even getting into the doctor’s office. How do we help patients engage with health behaviors, nutrition, and other factors that may prevent the onset of conditions? Health systems haven’t worked as frequently in that space, but now, particularly with technology and helping patients make decisions through AI and other tools, we’re exploring whether we can engage earlier. To do that, you need concepts for both the financing and the structure. There’s something there that could really help us on that dollar‑invested‑to‑health‑outcome equation, and we’re thinking about ways to explore it in new ways.

Rich Helppie  

I love that holistic look at everything and where people interact with the health system—maybe getting diagnosed better—and maybe that’s a spot for AI, because I know a lot of diseases present the same way.

Dr. David Miller  

It is. We talk a lot about AI and what it means broadly. I’ll use two examples. One is that technology‑enabled education is going to be very important. When I went to medical school back in the 90s, you’d go into a library and pore over a 400‑page book, almost memorizing it. Now that information is available at your fingertips. The questions are: how do you access it and how do you apply it? We have to understand educational models that support that transition—what it means to go through medical education, whether it’s medical school, nursing school, pharmacy, social work, or dentistry.

The second key element is that we’ve started to use AI effectively in care delivery to reduce administrative burden—helping with documentation and other areas. Next, we need to think seriously about its role in supporting us as diagnosticians. That’s an area with a lot of good work underway, and it connects back to that technology‑enabled education and understanding where and how to apply AI with the right connection to your clinician. That’s a really important area of progress over even the next six to twelve months.

Rich Helppie  

I can see that being a place where health care financing comes together with clinical care. It’s very common today that, before someone gets an MRI, the insurer requires an X‑ray, then a CT, and only then the MRI. Perhaps AI could look at that and say, “No, let’s skip using resources on X‑ray and CT and go directly to the MRI.”

Dr. David Miller  

I think we want to be simultaneously mindful of potential unintended consequences while not missing opportunities to do our work better on behalf of our patients. That’s an ongoing and really important conversation in health care.

Rich Helppie  

How do we get that into policy?

Dr. David Miller  

Much of health care policy, as you know, is based on the idea that we have a “gold standard” study—often a randomized controlled trial—and then that translates into payment policy and clinical policies. We’re learning how to study and understand the impact of these technology‑based interventions. There have been studies, for instance, on ambient AI for documentation that show clinicians spending less time in the electronic medical record and more time with patients. As we see more empirical evidence like that, adoption and implementation grow. That mindset—“we need the empirical evidence before widespread adoption”—still exists in health care. As that body of research grows, I think we’ll start to see acceleration.

Even recently, a Michigan study showed how AI‑assisted review of imaging studies for patients with suspected stroke can help with rapid triage, particularly in lower‑resource environments. I think we’re going to see more and more like that.

Rich Helppie  

I share your excitement. You mentioned lower‑resource environments. We’ve had a number of guests today talk about critical access hospitals and more remote, less urbanized areas. You’ve been expanding the footprint of Michigan Medicine across the state. How do you think about that part of your world and that part of your job?

Dr. David Miller  

Our mission is “We advance health to serve Michigan and the world,” and we look at opportunities to extend capabilities, expertise, and partnerships across the state. Many of the sites now within our University of Michigan Health–Sparrow members in Carson City and Ionia are lower‑resource, more rural environments.

We’ve been using technology to make the best use of the inpatient beds available in those sites. We’ve used technology to support assessments of patients at risk of stroke across the statewide network. We’re trying to understand tools and capabilities that work across our whole network, and we hope there are opportunities to export and expand them beyond University of Michigan Health. Those are the kinds of solutions that can help us move toward that important but sometimes elusive goal of higher quality, better outcomes, and lower cost. Technology and capability‑building have a role there. Finding those tools, and then finding ways to test and implement them, is a great challenge for us over the next several years.

Rich Helppie  

No conversation with you would be complete without talking about medical education: getting the best and brightest in, getting them graduated, and doing it in a way that doesn’t leave them burdened with hundreds of thousands of dollars of student debt, so they can focus on serving patients rather than serving that debt. What kinds of policies might we look at as a state to deal with that?

Dr. David Miller  

The cost of medical education is extraordinarily high. Some medical schools have been fortunate to receive significant philanthropic support that allowed them to go tuition‑free. We’re looking every day at ways to reduce the tuition burden as much as possible for our students, and at the same time, to keep as many of our talented graduates in Michigan as we can.

One differentiator at a place like Michigan Medicine is the tight coordination between the medical school and the clinical delivery system. For example, if we refine and develop a new technology‑enabled curriculum, we can simultaneously develop the clinical training sites where students move from the curriculum into care delivery and then into practice. That’s one of the strengths we have at Michigan and want to continue to leverage.

As medical schools and other health education programs start to think more about tech‑enabled education that leads to tech‑enabled care delivery, they’ll have an advantage in the marketplace for the next generation. This is something you’ve probably heard me say before, Rich: my parents, who are in their 80s, will always want to go to a bricks‑and‑mortar physician’s office where someone puts a stethoscope on them. My kids, who are in their 20s and teens, may never want to go into a traditional office—they’ll let their phone make contact. So we, as a health care delivery system and an educational system, have to learn how to meet both of those needs.

Rich Helppie  

Indeed. Any final comments for the audience today?

Dr. David Miller  

I’d say thank you to you for your commitment to health care delivery. I want to thank our team members at Michigan Medicine, who are absolutely extraordinary—bringing every bit of themselves every day to take care of our patients and our communities. And of course, go Blue.

Rich Helppie  

Go Blue. Thank you. We’ve been talking today with Dr. David Miller of Michigan Medicine—the University of Michigan Hospitals and the University of Michigan Medical School. For the Michigan Health and Hospital Association and *The Common Bridge* podcast and Substack page, this is your host, Rich Helppie, signing off.

Announcer  

Thank you for joining us on *The Common Bridge*, where we continue to seek clarity across divided lines. Subscribe and support *The Common Bridge* on Substack, YouTube, and wherever you listen to your favorite podcasts. Until next time, stay informed, stay engaged, and help build a bridge of common understanding.